Overweight, obesity and insulin resistance associated with them are major risk factors for a number of chronic diseases including diabetes and cardiovascular diseases (non-patent documents 1-4), especially, the global pandemic of diabetes is serious problem for public health and puts a huge burden on healthcare system in the world (non-patent document 5). Although various oral and injectable hypoglycemic drugs have been developed and launched, the efforts to stop or to slow down the growth rate of diabetes-related mortality and morbidity are not still going well. Postprandial hyperglycemia (PPH) which is one of phenomenon of blood glucose dysregulation seen in diabetes and impaired glucose tolerance (IGT) is cautioned as an independent risk factor for cardiovascular disease (non-patent documents 6-7). Close relation between PPH and carotid intima-media thickness suggested that PPH was associated with atherosclerosis (non-patent documents 8-9). Some recent studies imply that PPH causes vascular inflammation and endothelial dysfunction through oxidative stress during PPH (non-patent documents 10-11). Three types of oral anti-diabetics, α-glucosidase inhibitors, glinides and DPP4 inhibitors, were developed aiming to lower PPH. Acarbose, a member of the α-glucosidase inhibitors class, showed a promising result that its treatment reduce both the risk of diabetes progression in patients with IGT and the incidence of cardiovascular disease in its clinical trial “STOP-NIDDM” (non-patent documents 12-13), however, another drug, a member of the glinides class, nateglinide failed to show its benefits in the trial “NAVIGATOR” (non-patent document 14). In addition, two DPP4 inhibitors, saxagliptin and alogliptin, did not have benefits for cardiovascular disease risk reduction in their clinical outcome trials, “SAVOR-TIMI 53” (non-patent document 15) and “EXAMIN” (non-patent document 16), respectively. Considering such a wavering situation, more efficacious and safer anti-diabetic agents having potency to lower PPH should be desirable for suppressing diabetes epidemic and also relieving diabetic vascular complications. Screening for new compounds with lowering PPH resulted in finding newly synthesized cyanotriazol compounds which reduced PPH after meal loading in Zucker Diabetic Fatty rats, one of type 2 diabetes model rats which show severe hyperglycemia and insulin resistance. This result demonstrated that the cyanotriazol compounds would be applicable to treating diabetes and preventing diabetic various complications.
When metabolic disorders including diabetes, obesity and so on are considered, they are highly involved in energy imbalance between energy expenditure and calorie intake. Although proper dietary restriction and exercise are best means for improving the metabolic disorders (non-patent document 17), it has been proved that the efficacy by themselves was insufficient (non-patent document 19) and drug intervention facilitated raising the probability of achieving clinical treatment target. Thus, modulation, particularly augmentation, of cellular energy expenditure is an attractive drug target to correct such energy imbalance-related disorders. The citric acid cycle has pivotal and mandatory roles in the aerobic metabolism, which mainly reduces NAD+ to NADH and discharges carbon dioxide from metabolizing various energy substrates. We conceived that this cycle activation may lead to promote energy metabolism and expenditure, therefore we has conducted drug discovery screening to find synthetic chemical compounds with promoting citric acid cycle activity. Consequently, we found newly synthesized cyanotriazol compounds with strong efficacy on stimulating cellular citric acid cycle substrate consumption by measuring intracellular radiolabeled content derived from [14C]-citrate. For further certification, we employed an extracellular flux analyzer (XF24-3; Seahorse Bioscience) to measure actual carbon dioxide evolution rate (CDER) in cultured cells treated by several screened compounds (non-patent document 19). The analysis proved that the tested compounds accelerated not only CDER and but also oxygen consumption rate (OCR), which indicates energy expenditure is highly stimulated by the compounds.
In this invention, we found that newly synthesized cyanotriazole compounds have strong efficacy to improve hyperglycemia and/or to stimulate the citric acid cycle activity. Not limiting the usage as an anti-obesity and/or diabetic drug, expected profits by a cyanotriazol compound are curative or preventive effects on diseases or disorders related to energy imbalance which comes from less energy output than calorie intake, for example, impaired glucose tolerance, insulin resistance, diabetic complication, dyslipidemia, hepatic steatosis, atherosclerosis and/or cardiovascular disease, as well as diseases or disorders that would benefit from stimulating energy expenditure.
Patent Document 1 discloses a production method of cyanotriazole compounds.
Patent Document 2 and Non-Patent Documents 20-21 disclose a cyanotriazole compound as a human epidermis growth factor receptor 2 tyrosinase inhibitor.
Patent Document 3 discloses a production method of cyanotriazole compounds.
Patent Document 4 discloses a cyanotriazole compound as an inhibitor of fatty acid synthase.